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Individual
MRS. SUSAN A VINCENT
Active
Individual
MRS. SUSAN A VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
106939
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104967
MAGELLAN
MA
05
—
1890492
—
MA
01
—
755196
TUFTS HEALTH PLAN
MA
Enumeration date
12/02/2005
Last updated
12/04/2012
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